Pennsylvania Statutes Title 62 P.S. Poor Persons and Public Welfare § 801-G. Definitions

The following words and phrases when used in this article shall have the meanings given to them in this section unless the context clearly indicates otherwise:

“Assessment.” The fee, known as the Quality Care Assessment, authorized to be implemented under this article on every covered hospital.

“Bad debt expense.” The cost of care for which a hospital expected payment from the patient or a third-party payer, but which the hospital subsequently determines to be uncollectible, as further described in the Medicare Provider Reimbursement Manual published by the United States Department of Health and Human Services.

“Charity care expense.” The cost of care for which a hospital ordinarily charges a fee but which is provided free or at a reduced rate to patients who cannot afford to pay but who are not eligible for public programs, and from whom the hospital did not expect payment in accordance with the hospital's charity care policy, as further described in the Medicare Provider Reimbursement Manual published by the United States Department of Health and Human Services.

“Contractual allowance.” The difference between what a hospital charges for services and the amounts that certain payers have agreed to pay for the services as further described in the Medicare Provider Reimbursement Manual published by the United States Department of Health and Human Services.

“Covered hospital.” A hospital other than an exempt hospital.

“Critical access hospital.” Any hospital that has qualified under section 1861(mm)(1) of the Social Security Act (49 Stat. 620, 42 U.S.C. § 1395x(mm)(1)) as a critical access hospital under Medicare.

“Exempt hospital.” Any of the following:

(1) A Federal veterans' affairs hospital.

(2) A hospital that provides care, including inpatient hospital services, to all patients free of charge.

(3) A private psychiatric hospital.

(4) A State-owned psychiatric hospital.

(5) A critical access hospital.

(6) A long-term acute care hospital.

(7) A free-standing acute care hospital organized primarily for the treatment of and research on cancer in which at least 30% of the inpatient admissions had cancer as the principal diagnosis based on Pennsylvania Health Care Cost Containment Council CY 2014 inpatient discharge data. For the purposes of meeting this definition, only discharges with ICD-9-CM principal diagnoses codes of 140 through 239, V58.0, V58.1, V66.1, V66.2 or 990 are considered.

“Hospital.” A facility licensed as a hospital under 28 Pa.Code Pt. IV Subpt. B (relating to general and special hospitals). 1

“Long-term acute care hospital.” A hospital or unit of a hospital whose patients have a length of stay of greater than 25 days and that provides specialized acute care of medically complex patients who are critically ill.

“Medical assistance managed care organization.” A Medicaid managed care organization as defined in section 1903(m)(1)(a) of the Social Security Act (49 Stat. 620, 42 U.S.C. § 1396b(m)(1)(a)) that is a party to a Medicaid managed care contract with the department. The term shall not include a behavioral health managed care organization that is a party to a Medicaid managed care contract with the department.

“Net inpatient revenue.”Gross revenues received or earned by a hospital for inpatient services, including medical assistance supplemental revenues received by the hospital for inpatient hospital services, less any deducted amounts for bad debt expense, charity care expense and contractual allowances as identified in the hospital's records and reported on forms specified by the department.

“Net outpatient revenue.”Gross revenues received or earned by a hospital for outpatient services, including medical assistance supplemental revenues received by the hospital for outpatient hospital services, less any deducted amounts for bad debt expense, charity care expense and contractual allowances as identified in the hospital's records and reported on forms specified by the department.

“Program.” The Commonwealth's medical assistance program as authorized under Article IV.